Campbell Suzy J, Nery Susana V, Doi Suhail A, Gray Darren J, Soares Magalhães Ricardo J, McCarthy James S, Traub Rebecca J, Andrews Ross M, Clements Archie C A
Research School of Population Health, College of Medicine, Biology, and Environment, The Australian National University, Canberra, Australian Captial Territory, Australia.
Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
PLoS Negl Trop Dis. 2016 May 19;10(5):e0004566. doi: 10.1371/journal.pntd.0004566. eCollection 2016 May.
Soil-transmitted helminths (STH) have acute and chronic manifestations, and can result in lifetime morbidity. Disease burden is difficult to quantify, yet quantitative evidence is required to justify large-scale deworming programmes. A recent Cochrane systematic review, which influences Global Burden of Disease (GBD) estimates for STH, has again called into question the evidence for deworming benefit on morbidity due to STH. In this narrative review, we investigate in detail what the shortfalls in evidence are.
METHODOLOGY/PRINCIPAL FINDINGS: We systematically reviewed recent literature that used direct measures to investigate morbidity from STH and we critically appraised systematic reviews, particularly the most recent Cochrane systematic review investigating deworming impact on morbidity. We included six systematic reviews and meta-analyses, 36 literature reviews, 44 experimental or observational studies, and five case series. We highlight where evidence is insufficient and where research needs to be directed to strengthen morbidity evidence, ideally to prove benefits of deworming.
CONCLUSIONS/SIGNIFICANCE: Overall, the Cochrane systematic review and recent studies indicate major shortfalls in evidence for direct morbidity. However, it is questionable whether the systematic review methodology should be applied to STH due to heterogeneity of the prevalence of different species in each setting. Urgent investment in studies powered to detect direct morbidity effects due to STH is required.
土源性蠕虫（STH）有急性和慢性表现，可导致终生发病。疾病负担难以量化，但需要定量证据来证明大规模驱虫计划的合理性。最近一项影响全球疾病负担（GBD）对STH估计的Cochrane系统评价，再次对驱虫对STH所致发病的益处的证据提出质疑。在这篇叙述性综述中，我们详细调查了证据的不足之处。
方法/主要发现：我们系统地回顾了最近使用直接测量方法调查STH发病率的文献，并对系统评价进行了批判性评估，特别是最近一项调查驱虫对发病率影响的Cochrane系统评价。我们纳入了六项系统评价和荟萃分析、36篇文献综述、44项实验性或观察性研究以及五个病例系列。我们强调了证据不足的地方以及需要开展研究以加强发病率证据的方向，理想情况下是为了证明驱虫的益处。
结论/意义：总体而言，Cochrane系统评价和最近的研究表明直接发病率证据存在重大不足。然而，由于每种情况下不同物种流行率的异质性，是否应将系统评价方法应用于STH值得怀疑。需要紧急投资开展有足够效力检测STH所致直接发病影响的研究。
